Pregnancy after uterine fibroid embolization: follow-up of 100 patients embolized using tris-acryl gelatin microspheres.

OBJECTIVE: To evaluate pregnancies in women who had previously undergone uterine fibroid embolization. DESIGN: Prospective study. SETTING: A city hospital in Spain. PATIENT(S): A cohort of 100 uterine fibroid embolization patients, 57 of whom wished to preserve their fertility. INTERVENTION(S): Uterine arteries were embolized by using 500-1,200 microm tris-acryl gelatin microspheres. After intervention, patient follow-up was performed at 1 week, 3 months, 6 months, and yearly. MAIN OUTCOME MEASURE(S): The number of pregnancies and course of pregnancy. RESULT(S): Eleven pregnancies in 10 women (19.2%). The pregnancies resulted in 8 live births, including 4 normal and 4 cesarean deliveries. Early miscarriage occurred in 3 cases (2 patients). None of the 8 newborns was a low-birth weight infant, and gestation lasted >or=37 weeks in all the patients, except for 1 case of a macrosomic fetus delivered at 33 weeks. There were no cases of abnormal placental implantation. CONCLUSION(S): Despite the small sample size, uterine artery embolization appears to be viable in young women who still want to become pregnant. Larger series and studies comparing uterine fibroid embolization and myomectomy are needed.

Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.

PURPOSE: The purpose of the study was to determine the difference in findings between recumbent and upright-sitting MRI of the cervical and lumbosacral spine in patients with related sign and symptoms. MATERIALS AND METHODS: A total of 89 patients were studied (lumbosacral spine: 45 patients; cervical: 44 patients). T1-weighted (TR: 350, TE: 20) fast spin echo and T2-weighted (TR: 2500, TE: 160) fast spin echo images were acquired in the sagittal and axial planes in both the recumbent and sitting-neutral positions. The images were acquired on the Upright MRI unit (Fonar Corporation, Melville, NY). Differences were sought between the recumbent and upright-sitting positions at all levels imaged, in both planes. RESULTS: The total number of cases of pathology was 68, including instances of posterior disc herniation and anterior and posterior spondylolisthesis. Focal posterior disc herniations were noted in 55 patients (cervical: 31, lumbosacral: 24) [62% of patients]. Six of these herniations (cervical: 4, lumbosacral: 2) [11%] were seen only on the upright-sitting study. Focal posterior disc herniations were seen to comparatively enlarge in size in 35 patients on the upright-seated examination (cervical: 21, lumbosacral: 14) [72%], and reduce in size in 9 patients (cervical: 5, lumbosacral: 4) [18%]. Degenerative anterior (n: 11) and posterior (n: 2) spondylolisthesis was seen in 13 patients (cervical: 0, lumbosacral: 13) [15% of patient total]. Anterior spondylolisthesis was only seen on the upright-seated examination in 4 patients (cervical: 0, lumbosacral: 4) [31%]. Anterior spondylolisthesis was comparatively greater in degree on the upright-seated study in 7 patients (cervical: 0, lumbosacral: 7) [54%]. Posterior spondylolisthesis was comparatively greater in degree on the recumbent examination in 2 patients (cervical: 0, lumbosacral: 2) [15%]. The overall combined recumbent miss rate in cases of pathology was 15% (10/68). The overall combined recumbent underestimation rate in cases of pathology was 62% (42/68). The overall combined upright-seated underestimation in cases of pathology was 16% (11/69). CONCLUSIONS: Overall, upright-seated MRI was found to be superior to recumbent MRI of the spine in 52 patents (recumbent missed pathology [n: 10]+recumbent underestimated pathology [n: 42]=52/89 total patients: 58%) in cases of posterior disc herniation and anterior spondylolisthesis. This seems to validate the importance of weight-bearing imaging in the spine that might be expected to unmask positional enlarging disc herniations and worsening spondylolisthesis. Overall, recumbent MRI was found to be superior to upright-seated MRI in 11 cases (11/89: 12%). The latter finding was possibly due to the fact that upright seated position is actually partial flexion that might be expected to reduce some cases of hypermobile posterior spondylolisthesis.